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>> LIKE A CONVEYOR BELT TO PROCESS FOOD, OUR GASTROINTESTINAL TRACT
TRANSFORMS WHAT WE EAT INTO THE ELEMENTS WE NEED TO SURVIVE.
PROBLEMS ALONG THE G.I. TRACT TONIGHT "ON CALL WITH THE PRAIRIE DOC."
>> GOOD EVENING AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
"WE ARE WHAT WE EAT." OR SO THE SAYING GOES. BUT HOW OUR BODIES CONVERT OUR
DINNERS INTO THE NUTRIENTS WE NEED IS AMAZING.
IT IS A SIX TO SEVEN-YARD-LONG SYSTEM THAT IS PACKED INTO OUR BODY.
THE DIGESTIVE TRACT CAN HAVE ITS PROBLEMS TOO.
FOR EXAMPLE, ULCERATIVE COLITIS IS AN INFLAMMATORY BOWEL DISEASE THAT AFFECTS ABOUT 700,000 AMERICANS.
WE'LL BE ANSWERING YOUR QUESTIONS ABOUT THIS TONIGHT.
FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
PICK THE BEST ANSWER. BEST ANSWER.
SCREENING FOR COLORECTAL CANCER:
A. SHOULD BEGIN AT AGE 40?
B. AT BARE MINIMUM SHOULD INVOLVE CHECKING THE STOOL FOR BLOOD YEARLY AFTER THE AGE OF 50?
OR C. INVOLVES HAVING A COLONOSCOPY EVERY FIVE YEARS STARTING AT AGE 55?
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED
COPY OF OUR BOOK, "THE PICTURE OF HEALTH."
EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW,
COMES WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!
WE ANSWER YOUR MEDICAL QUESTIONS ABOUT THE G.I. TRACT ALL NIGHT LONG,.
AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL. CALL IN QUESTIONS TO 1-888-376-6225.
OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
JOINING US TONIGHT ARE DR. CRISTINA HILL JENSEN, AVERA MEDICAL GROUP GASTROENTEROLOGY
AND DR. TIM RIDGWAY, DEAN OF FACULTY AFFAIRS, USD SANFORD SCHOOL OF MEDICINE.
WELCOME, THANK YOU FOR BEING ON THE SHOW ONCE AGAIN.
WE'RE KIND OF GOING OVER, YOU'VE BEEN ON THE SHOW, LIKE, FIVE TIMES.
>> YES.
>> AND YOU'VE BEEN ON IT EIGHT.
>> SEVEN OR EIGHT, I THINK, SOMEWHERE CLOSE TO THAT. SO, IF YOU DO THIS KIND OF A
TELEVISION SHOW LONG ENOUGH, AND YOU HAVE GOOD FRIEND, YOU KIND OF INCLUDE THEM AS MUCH AS YOU CAN.
GOOD FRIENDS. THANKS FOR DOING THIS.
>> THANKS FOR HAVING US BACK.
>> CRISTINA, WHERE ARE YOU FROM AND WHAT GOT YOU INTO MEDICINE? TELL US THAT LITTLE STORY.
>> SURE. I'M FROM BROOKINGS, SOUTH DAKOTA, ORIGINALLY.
MY MOTHER WAS A NURSE, I LOVED BEING IN THE HOSPITAL, SO FROM A VERY YOUNG AGE I KNEW I
WANTED TO BE A PHYSICIAN. SO I WENT TO MEDICAL SCHOOL AT THE UNIVERSITY OF SOUTH
DAKOTA, BECAME AN INTERNIST, INTERNAL MEDICINE AT TULANE UNIVERSITY, AND THEN I REALLY
ENJOYED THE G.I. TRACT, I LIKED THE IDEA OF DOING PROCEDURES, AS WELL AS A LOT OF THINKING AND THEN SEEING
PATIENTS IN CLINIC IN THE AFTERNOON, FOR ME WAS A PERFECT MIX.
SO I STARTED MY FELLOWSHIP AT TULANE UNIVERSITY IN NEW ORLEANS AND THEN FINISHED UP AT THE UNIVERSITY OF IOWA.
>> INTERRUPTED BY A HURRICANE.
>> AND HURRICANE KATRINA.
>> THAT'S RIGHT.
>> SENT ME NORTH, YES. IT DID, IT DID. AND I'VE BEEN HERE IN SIOUX FALLS FOR TEN YEARS. PRACTICING AT AVERA.
>> YOU HAVE HOW MANY CHILDREN?
>> I HAVE ONE SON, WHO IS 7 1/2. YEAH.
>> SO, TIM, TELL US A LITTLE BIT ABOUT YOUR EXPERIENCE.
>> WELL, I'M FROM A LITTLE TOWN CALLED RAVINE A, SOUTH DAKOTA, I'D LOVE TO KNOW HOW
MANY OF OUR VIEWERS HAVE HEARD OF THAT.
I LOVED GOING OUT AND DEALING WITH THE ANIMALS, UNTIL I GOT KICKED ONE TOO MANY TIMES, AND
THOUGHT, WELL, MAYBE MEDICINE WOULD BE MY CALL.
>> THEY STILL KICK YOU BUT NOT QUITE AS HARD.
>> EXACTLY. SO I, TOO, WENT TO THE UNIVERSITY OF SOUTH DAKOTA, LIKE CRISTINA.
I DID MY FELLOWSHIP AT THE MAYO CLINIC. CAME BACK TO SOUTH DAKOTA. I'VE BEEN HERE 26 YEARS NOW.
BUT MY PATH TOOK A LITTLE BIT DIFFERENT COURSE.
I STILL LOVE SEEING PATIENTS. BUT I ALSO LOVE EDUCATION. AND TEN YEARS AGO, THE MEDICAL
SCHOOL CAME CALLING, AND SO I HAVE AN OPPORTUNITY TO TRY TO MOLD THE NEXT GENERATION OF
STUDENTS, WHICH IS A WONDERFUL THING, AND I STILL PRACTICE GASTROENTEROLOGY AT THE V.A.
WHICH HAS BEEN A GREAT THING FOR ME TO GIVE BACK TO OUR VETERANS.
>> SO IT'S A JOY TO HAVE THIS EXPERIENCE, THIS GASTROENTEROLOGY EXPERIENCE,
BUT YOU HAVE A DIFFERENT KIND OF EXPERIENCE, BOTH OF YOU.
TELL US A LITTLE BIT ABOUT WHAT YOUR COMMON DAY'S ALL ABOUT.
>> SURE, MY MORNINGS ARE SPENT DOING PROCEDURES.
SO THAT LONG, FLEXIBLE TUBE, THE CAMERA ON THE END OF IT, I LOOK INSIDE.
SO I GO AND I SPEND TIME DOING UPPER ENDOSCOPY, LOOKING AT THE ESOPHAGUS, STOMACH, AND
THEN SPEND A LOT OF TIME IN THE COLON AS WELL, SCREENING FOR COLON CANCER.
IN THE AFTERNOON, I SEE PATIENTS IN CLINIC.
MY AREA OF INTEREST, I REALLY ENJOY WORKING WITH PATIENTS WHO HAVE CELIAC DISEASE, AS
WELL AS INFLAMMATORY BOWEL DISEASE.
SO CROHN'S DISEASE AND ULCERATIVE COLITIS AS WELL.
>> SO WE'RE GOING TALK ABOUT CELIAC IN A MINUTE.
>> SURE.
>> BUT I WANT TO TALK ABOUT YOUR DAY, TYPICALLY YOU HAVE TWO HALF DAYS -- TWO DAYS --
>> IT IS NOT BORING AT ALL, RICK.
I FEEL, LIKE I SAID, I'M DIRECTOR OF THE ENDOSCOPY UNIT AT THE V.A. HOSPITAL.
I'M WHAT WE CALL ANINTERVENTIONAL ENDOSCOPIST.
SO I WILL TAKE THE MORE COMPLEX PROCEDURES THAT NEED TO BE DONE AT THE V.A. AND I
SPEND THREE HALF DAYS A WEEK DOING THAT.
BUT THEN AT THE MEDICAL SCHOOL, AS YOU SAID, I'M DEAN OF FACULTY AFFAIRS, MEANING I
OVERSEE OUR WONDERFUL FACULTY, ALL OF WHO HAVE BEEN ON YOUR SHOW AND DONE A WONDERFUL JOB.
THAT IS JUST A REALLY FUN JOB.
BUT I ALSO GO DOWN TO VERMILLION AND I GET OUR STUDENTS BRIGHT-EYED AND FRESH.
>> BUSHY-TAILED.
>> BUSHY-TAILED AND WE TEACH BY ORGAN SYSTEM.
SO I HELP GIVE THEM THE CLINICAL ASPECTS OF GASTROENTEROLOGY AND THE G.I. TRACT.
IT KEEPS ME HONEST, MAKES ME GOOD AT WHAT I DO, BECAUSE I
BETTER KNOW THE ANSWERS TO THEIR QUESTIONS.
>> YES. ONE OF THE THINGS THAT WE TALKED ABOUT EARLIER BEFORE THE CAMERA WAS ABOUT PEOPLE
WHO HAVE TROUBLE SWALLOWING. FOOD GETS CAUGHT IN THEIR THROAT.
EXPLAIN TO US WHAT THE WORD DYSPHAGIA MEANS.
>> DYSPHAGIA IS SOMETHING THAT I THINK MANY PEOPLE DON'T EVEN REALIZE IS AN ABNORMALITY. AND IT IS.
BUT THE CLASSIC STORY IS, PEOPLE WILL COME IN AND THEY'LL SAY, DOC, I'M EATING FOOD AND IT GETS STUCK.
AND I'LL HAVE TO DRINK WATER, I HAVE TO POSTURE MYSELF, AND EVENTUALLY IT GOES THROUGH,
BUT EVERY NOW AND THEN IT GETS STUCK AND THEN THEY HAVE TO COME TO US WHERE WE HAVE TO GO AND REMOVE IT.
COMMONLY THAT IS NOT A NORMAL SYMPTOM AND IT HAS TO BE INVESTIGATED.
ONE OF THE MOST COMMON CAUSES IS THE BENIGN STRICTURE OR A SCARRING OF THE ESOPHAGUS.
AND THAT'S DUE TO ACID REFLUX.
WE'VE TALKED ABOUT ACID REFLUX ON THIS SHOW, AND I THINK OUR VIEWERS PROBABLY UNDERSTAND IT PRETTY WELL BY NOW.
BUT WHAT HAPPENS IS, THIS ACID, AS IT REGURGITATES TO THE ESOPHAGUS,
THE ESOPHAGUS WILL TRY TO HEAL JUST LIKE IF WE CUT OUR HAND.
>> RIGHT.
>> AND IT SCARS. AND, SO, THE ESOPHAGUS WILL NARROW DOWN, AND IF YOU EAT A SOLID -- IT'S USUALLY
SOMETHING SOLID, DRY BREAD, CHICKEN, MEATS.
>> DRY CHICKEN.
>> DRY CHICKEN IS A CLASSIC ONE. OR ON THANKSGIVING, GUARANTEED, WE'RE GOING TO SEE SOMEBODY COME IN.
>> I DID, THIS YEAR.
>> WHEN YOU'RE ON CALL THANKSGIVING, IT HAPPENS. AND IT CAN BE SERIOUS BECAUSE
IF YOU CAN'T GET ANYTHING THROUGH, SOME PEOPLE CAN ASPIRATE OR THEIR SALIVA WILL
NOT BE HANDLED AND IT WILL GO INTO THE LUNGS AND CAUSE A SERIOUS PROBLEM.
SO IF YOU HAVE THAT, DEFINITELY SHOULD BE INVESTIGATED.
>> WELL, THE WORRY THAT I ALWAYS HAVE AND I REMEMBER HEARING THIS IS DYSPHAGIA IS CANCER UNTIL PROVEN OTHERWISE.
NOW, YOU OBVIOUSLY THINK THAT THAT'S A CONSIDERATION BECAUSE YOU RECOMMENDED BEING -- TO HAVE IT FOLLOWED UP.
>> ABSOLUTELY. THAT USUALLY -- USUALLY THAT REQUIRES AN ENDOSCOPY BECAUSE
NOT ONLY CAN WE DIAGNOSE THE PROBLEM, BUT WE CAN ACTUALLY STRETCH THE ESOPHAGUS IF THERE'S A BENIGN STRICTURE.
NOW, CANCER CAN BE A CAUSE OF THIS.
USUALLY, SOMEONE WILL COME IN AND TELL US, IT'S BEEN WITHIN A YEAR, AND IT'S GETTING WORSE.
THAT SCARES US. AND THAT'S CANCER UNTIL PROVEN OTHERWISE.
OTHER PEOPLE WILL COME IN AND SAY, YOU KNOW, DOC, I'VE HAD THIS FOR ABOUT SIX YEARS, IT'S
OFF AND ON, IT'S STARTING TO GET WORSE, IT STILL NEEDS TO BE INVESTIGATED BUT LESS
LIKELY TO BE CANCER AND MORE OF A BENIGN CONDITION.
>> AND THEN THERE'S THIS OTHER CATEGORY, TOO, THE YOUNGSTERS, I CALL THEM, THE YOUNG
24-YEAR-OLD MAN, YOU KNOW, I HAVE A LITTLE BIT OF ALLERGIES AND OCCASIONALLY I JUST FEEL
THAT PIECE OF FOOD GETTING STUFF. THAT'S A CATEGORY CALLED ESOPHAGITIS.
>> THAT'S A NEW DIAGNOSIS.
>> WE CAN SEE THIS ALMOST ALLERGIC-LIKE REACTION IN THE ESOPHAGUS.
AND IT'S A REALLY UNIQUE SUBSET IN OUR YOUNGSTERS.
>> OUR YOUNGSTERS.
>> 20-YEAR-OLDS.
>> 20-YEAR-OLDS, 30-YEAR-OLDS, 40-YEAR-OLDS.
>> YEAH. WHY IN THE HECK DO THEY GET ESOPHAGITIS.
>> SO WE'RE STILL TRYING TO FIGURE IT OUT.
THERE'S THE INFLUX OF THE INFLAMMATORY CELLS, IN SOME PEOPLE, IT'S ACTUALLY DUE TO CERTAIN FOOD ITEMS.
I HAVE A PATIENT WHO CANNOT EAT CORN, FOR INSTANCE.
>> FOOD ALLERGY, MAYBE.
>> RIGHT. POSSIBLY.
>> PARASITE.
>> NO, NO PARASITE. NO, NO PARASITE YET. BUT WE'RE STILL TRYING TO
FIGURE OUT WHAT THE IMMUNE SYSTEM IS DOING TO CAUSE THIS REACTION, ALL THESE
INFLAMMATORY CELLS. AND THIS ALSO CAN CAUSE CONSIDERABLE SCARRING.
>> OH, YES.
>> AS WELL. IT CAN BE REALLY CHALLENGING.
>> AND THEN THEY'LL HAVE THE DYSPHAGIA AGAIN.
>> EXACTLY.
>> SO THE TAKE-HOME IS, GET IT INVESTIGATED.
>> YOUNG OR OLD.
>> YOU CAN TREAT IT, TOO, CAN'T YOU?
>> IT'S VERY TREATABLE.
>> YEAH, EXACTLY.
>> TELL US A LITTLE BIT ABOUT -- WELL, ONE MORE COMMENT.
I WANT TO TALK ABOUT CANCER OF THE ESOPHAGUS BECAUSE IT REALLY IS HARD TO CATCH EARLY.
THE CLUE IS, RIGHT, DYSPHAGIA. HOW COMMON IS IT? NOT THAT COMMON BUT IT DOES OCCUR.
WHAT IS IT, THE PERSON WHO HAS CONSTANTLY REFLUX THAT GETS CANCER?
>> WELL, NOT NECESSARILY. AND I THINK, YOU KNOW, THOSE PATIENTS ARE THE ONES THAT
WE'RE FOLLOWING AND SAYING, WELL, YOU KNOW, MAYBE WE SHOULD TAKE A LOOK, AND THE
ONES I WORRY ABOUT ARE THE ONES WHO HAVE SILENT REFLUX.
AND THOSE ARE THE ONES WHO WILL HAVE BARRETT ESOPHAGUS OR PRECANCEROUS CONDITION.
AND THEY WON'T KNOW BECAUSE THEY DON'T HAVE THE TYPICAL, YOU KNOW, EAT A BIG SPICY MEAL
AND HAVE THAT HEARTBURN OR REFLUX COMING UP.
SO WE CAN SEE INDIVIDUALS WHO DON'T REALLY HAVE TYPICAL
HEARTBURN SYMPTOMS WHO CAN DEVELOP ESOPHAGEAL CANCER AS WELL.
>> SO, MY CONCERN IS, OF COURSE, ANY TIME THAT'S NOT WORKING AND YOU'RE ABOVE THE AGE OF --
>> 5-0.
>> 5-0.
>> THE MAGIC.
>> 5-0, IS A BAD SIGN FOR CANCER.
I WANTED TO MAKE A POINT ABOUT HAVING YOU GUYS GIVE US A CALL.
THINK ABOUT IT. THE QUESTIONS ARE IMPORTANT TO US.
WE NEED YOUR QUESTIONS. THIS IS YOUR SHOW. GASTROINTESTINAL SYSTEM. THERE'S A MILLION QUESTIONS OUT THERE.
>> HAVING MOST ANY DISEASE CAN BRING ABOUT SOME DEPRESSION. BUT HOW YOU DEAL EMOTIONALLY
WITH YOUR DISEASE CAN AFFECT YOUR PROGNOSIS.
>> MY MOTHER WAS HELEN WOOD AND SHE WAS A HIGH SCHOOL TEACHER IN STEPGUARD,
ARKANSAS, SHE TAUGHT THE BUSINESS COURSES. AND IN THE EARLY '60s, SHE DEVELOPED OVARIAN CYSTS THAT
WOULD BURST AND SHE WOULD PASSOUT.
SO, THEY DECIDED TO TAKE OUT HER FEMALE ORGANS, HAD A HYSTERECTOMY AND IN THE COURSE
OF DOING THAT, THEY FOUND SOME PLACES OF CANCER IN THE FALLOPIAN TUBES.
SO THEY DECIDED THEY SHOULD DO SOMETHING RIGHT AWAY WITH THAT.
AND, SO, SHE HAD CHEMO AND RADIATION, AND THE RADIATION GAVE HER SOME BURNING OF THE SKIN AND SO FORTH.
BUT IT PUT IT OFF INTO REMISSION FOR A NUMBER OF YEARS.
BUT THEN IT DEVELOPED INTO COLON CANCER. SHE FOUND A COLON CANCER, JUST POKING AROUND AT HER STOMACH,
AND SHE WENT IN TO THE LOCAL DOCTOR AND HE DECIDED TO DO SURGERY. ON THAT.
AND SHE WAS PUT ON CHEMO AND DID REALLY WELL ON CHEMO. SHE NEVER LOST HER HAIR.
AND SHE HAD A REAL POSITIVE ATTITUDE TOWARD THAT.
AND SHE WAS TEACHING. THEY HAD DONE AN ILEOSTOMY THE FIRST TIME, THAT'S SOMETHING ON THE SMALL INTESTINE, UP
HIGH, AND THEN THEY RESTORED IT.
I THINK IT WAS SEVERAL YEARS LATER, SHE DEVELOPED ANOTHER TUMOR, SLOW-GROWING TUMORS. AND SHE HAD A COLOSTOMY AT THAT POINT.
AND SHE STAYED ON CHEMO FOR A LITTLE WHILE. YOU KNOW, IT TOOK A WHILE TO TAKE CARE OF IT.
BUT SHE WAS RESPONDING REALLY REALLY WELL TO CHEMO AND SO FORTH.
SHE WENT THROUGH THAT SITUATION FOR 14 YEARS, FROM '62 TO '76.
AND THEN SHE FINALLY PASSED AWAY.
IT FINALLY GOT INTO HER ENTIRE SYSTEM, IT METASTISIZED.
BUT SHE HAD A REALLY GOOD OUTLOOK ON HAVING THE DISEASE,
AND SHE LIVED WITH THE DISEASE AND SHE WOULD REALLY ENCOURAGE HER FRIENDS AT THAT TIME, ONE
OF THE TEACHERS PUT HER HOUSECOAT ON AND, YOU KNOW, DIDN'T COME OUT OF IT, AND
MOTHER WOULD SAY, GET OUT OF YOUR HOUSECOAT AND GO DO SOMETHING.
MOTHER WAS SUBSTITUTE TEACHING EVEN THOUGH SHE HAD A COLOSTOMY.
SHE JUST WENT THROUGH IT AND DID EVERYTHING POSITIVELY.
AND I THINK THERE IS A BRAIN/BODY CONNECTION.
AND NOT TO SAY THAT THOSE PEOPLE THAT DIE OF CANCER SUDDENLY, YOU KNOW, SHE
PROBABLY CAUGHT IT EARLY AND THEN THE DIFFERENT MEDICATIONS, YOU KNOW, TOOK
OVER AND KEPT HER IN REMISSION FOR A NUMBER OF YEARS.
>> THANK YOU FOR THAT INTERVIEW.
THE VALUE OF A POSITIVE ATTITUDE, WOW.
I WOULD SAY AGAIN TO YOU THAT THIS IS YOUR SHOW, YOUR QUESTIONS ARE KEY TO OUR SHOW DISCUSSION.
CALL IN YOUR QUESTIONS ABOUT THE DIGESTIVE SYSTEM TO 1-888-376-6225 OR SEND US AN EMAIL TO ASK@PRAIRIEDOC.ORG.
AND WE DO HAVE SOME QUESTIONS. ANY COMMENT ABOUT HER STORY ABOUT HER MOM?
>> I LOVE THE ATTITUDE PART BECAUSE I THINK ALL OF US HAVE SEEN PATIENTS WHO COME IN TO
THINGS WITH SUCH A TREMENDOUS ATTITUDE AND HOW THEY DO WELL.
BUT THEN YOU'LL GET TO A POINT WHERE THEY REALIZE THAT THE QUALITY OF LIFE ISN'T THERE.
IT'S AMAZING HOW THEY ARE VERY PEACEFUL AND SAY, YOU KNOW WHAT, ENOUGH IS ENOUGH AND WE WILL SEE THEM DIE WITHIN A
SHORT PERIOD OF TIME. I THINK THAT MIND/BRAIN CONNECTION IS HUGE.
>> POWERFUL.
>> YEAH, VERY MUCH.
>> WHAT KIND OF A DIET SHOULD YOU FOLLOW IF YOU HAVE DIVERTICULITIS?
>> WELL, WE USED TO SAY, OR SOME USED TO SAY, AVOID POPCORN, NUTS AND SEEDS.
>> KERNELS.
>> RIGHT. BUT ACTUALLY THEY'VE LOOKED AND DONE WHAT'S CALLED A META-ANALYSIS AND REVIEWED ALL
THESE STUDIES AND LOOKED AT PATIENTS, A LARGER GROUP OF PATIENTS, I THINK GREATER THAN
10,000, AND THIS WAS ABOUT FOUR TO FIVE YEARS AGO, AND FOUND OUT THAT IT DOESN'T
MATTER IF YOU EAT POPCORN, NUTS, OR SEEDS, YOU NEED TO EAT A HEALTHY DIET, A HIGH-FIBER DIET, YOU NEED TO
STAY ACTIVE, YOU WE NEED TO STAY TRIM.
OBESE PATIENTS HAVE A HIGHER RISK OF DIVERTICULITIS.
>> I LOVE THAT QUESTION. I LOVE THAT QUESTION BECAUSE TO THIS DAY, WE WILL SEE PATIENTS COME IN THAT WERE
TOLD, THEY NEED TO AVOID -- THINK ABOUT IT. THE FOODS WITH SEEDS,
TOMATOES, VEGETABLES, THEY'RE GOOD FOR YOU.
AND WE WERE IGNORING THOSE AND STAYING AWAY FROM THEM FOR YEARS FOR NO GOOD REASON.
>> DOING THE WRONG THING. WE THOUGHT WE WERE RIGHT.
>> WELL, SURE, WE DID.
>> THE STORY OF MEDICINE RIGHT ACROSS THE BOARD, ISN'T IT?
WE CHANGE OUR MINDS ABOUT THINGS, WHEN WE HAVE SCIENCE THAT SUPPORT IT.
YOU KNOW, WE NEED MORE FIBER AND NOT LESS. THAT'S MY ANSWER, TOO, I LIKE
GROUND FLAX SEED FOR PEOPLE AS A GOOD SOURCE OF FIBER.
AND IT HAS FISH OIL EQUIVALENT WITH IT, SO THAT DOES HEART GOOD AND HELPS YOUR BOWELS WORK REGULARLY, ALL THOSE GOOD THINGS.
>> YES.
>> HAS GRD, HAS BARRETT'S, IS THERE SOMETHING TO BE DOING AT HOME TO HELP PREVENT,
CONTROL -- TO PREVENT, CONTROL OR THE GROWTH, 90-YEAR-OLD,WHO HAS GERD, LET'S EXPLAIN
WHAT GASTROESOPHAGEAL REFLUX DISEASE IS.
>> WHAT IT IS, CONTRARY TO POPULAR BELIEF, IT'S NOT AN OVERPRODUCTION OF ACID.
IT'S SIMPLY THAT WHEN WE EAT, THE STOMACH STIMULATES A HUGE AMOUNT OF ACID PRODUCTION.
AND ORDINARILY, THERE'S A SPHINCTER MUSCLE, A VALVE, THAT WILL CLOSE, AND ALLOW THE
STOMACH TO CHURN ACID AND BREAK DOWN FOOD INTO SMALL PARTICLES.
BUT WITH ACID REFLUX, THAT VALVE IS A LITTLE DEFICIENT, IT'S RELAXED, AND, SO, THE
ACID, INSTEAD OF STAYING IN THE STOMACH, WILL REGURGITATE UP INTO THE STOMACH WHERE IT DOESN'T BELONG.
CERTAIN INDIVIDUALS, OVER MANY YEARS, THAT ACID WILL CHANGE THE LINING OF THE ESOPHAGUS,
TO ACTUALLY LOOK LIKE THE LINING OF THE STOMACH. THAT IS --
>> YOU WOULD THINK THAT THAT WOULD BE PROTECTIVE, RIGHT?
>> YOU KNOW, IT'S INTERESTING, BECAUSE MANY OF THEM, THEIR HEARTBURN WILL GO AWAY.
>> BECAUSE THEY NOW HAVE LINING OF THE STOMACH KIND OF LINING.
>> AND SHE WAS TALKING ABOUT THE SILENT, AND THOSE ARE THE PEOPLE, YOU WORRY ABOUT.
NOW, WHO'S AT RISK FOR IT? MALE, SORRY, GUYS, BUT MALE. AND WE'RE LEARNING NOW OVERWEIGHT.OBESITY.
>> WILL HAVE MORE OF THE BARRETT'S SO JUST -- ESOPHAGUS?
>> YES. WHAT CAN YOU DO IF YOU HAVE BARRETT'S TO PREVENT?
AND THE BOTTOM LINE IS, IF YOU CAN MAINTAIN AND REDUCE THE ACID REFLUX AS MUCH AS
POSSIBLE WITH MEDICATIONS, AND THEN WE DO SURVEILLANCE OF THE ESOPHAGUS EVERY SO OFTEN TO LOOK FOR THAT SMALL
PERCENTAGE, WE'RE ACTUALLY LEARNING THAT THE RISK OF CANCER IS NOT AS HIGH AS WE THOUGHT IT ONCE WAS.
>> IT'S LIKE HOW MUCH? 1% PER YEAR?
>> SHORT SEGMENT BARRETT'S, LESS THAN THREE CENTIMETERS, 0.5% PER YEAR, VERY VERY LOW.
>> AND THE MAJORITY IS SHORT SEGMENT BARRETT'S?
>> EXACTLY.
>> IF IT'S WAY UP, THEN IT'S A LOT BIGGER --
>> IT CAN GO UP TO 6% PER YEAR.
BUT, AGAIN, JUST LIKE I TOLD MY PATIENTS WHO HAVE A COLON POLYP, YOU NEED TO GET INTO
THE SURVEILLANCE PROGRAM, SO WE GO, WE LOOK, WE BIOPSY, SAMPLE.
>> MAKE SURE THAT THEY'RE SAFE.
>> BECAUSE IF YOU FIND ANYTHING EARLY, WITH CANCER, YOU CAN ACTUALLY REMOVE IT THROUGH THE TELESCOPE.
>> RATHER THAN --
>> RATHER THAN HAVE ESOPHAGEAL CANCER SURGERY.
>> HE'S 90 YEARS OF AGE.
>> EXACTLY. I'M GLAD YOU BROUGHT THAT UP.
>> WE THINK HE MAY HAVE PRESBYESOPHAGUS. WHAT IS THAT?
>> ABNORMAL CONTRACTIONS OF THE ESOPHAGUS, WITH PRESBYESOPHAGUS.
>> INSTEAD OF THE NICE TOOTHPASTE TUBE, IT'S KIND OF CHAOTIC. DOES THAT GIVE YOU SYMPTOMS?
>> SURE, PEOPLE CAN HAVE CHEST PAIN, MORE DIFFICULTY WITH SWALLOWING AS WELL.
>> OKAY. ALL RIGHT.
AND THIS GUY'S 90, VERY INTERESTING. GOOD FOR HIM.
THANKS FOR WATCHING. I'M A 77-YEAR-OLD FEMALE FROM SIOUX FALLS AND SUFFERING FROM
CONSTANT CONSTIPATION, IS IT SAFE FOR ME TO TAKE MILK OF MAGNESIA EVERY NIGHT?
>> THERE WAS A MYTH OUT THERE SAYING YOU COULDN'T TAKE STIMULANT LAXATIVES FOR A LONG
PERIOD OF TIME BECAUSE THEY WOULD ACTUALLY HURT YOUR COLON AND MAKE IT EVEN MORE PRONE TO
CONSTIPATION BECAUSE OF LESS CONTRACTION.
THAT IS NOT THE CASE. IT DEPENDS HOW MUCH. NOW, OBVIOUSLY WE DON'T WANT
OUR PATIENTS TAKING A HALF A BOTTLE OF MILK OF MAGNESIA ON A GIVEN DAY, IT HAS MAGNESIUM IN IT AND YOU CAN GET
MAGNESIUM TOXICITY. BUT A SMALL AMOUNT, IF IT IS HELPING THE COLON, REALLY
SHOULD BE RELATIVELY SAFE. AGAIN, I WOULD ENCOURAGE THE VIEWER THAT HIGH-FIBER DIET, VERY IMPORTANT.
I ALWAYS TELL PEOPLE, DRINK PLENTY OF WATER. IN OUR WESTERN CULTURE, WE
JUST DON'T DRINK ENOUGH FLUIDS, AND THAT CAN HAVE AN IMPACT AS WELL.
BUT I DON'T KNOW WHAT YOUR FEELING IS, BUT MILK OF MAGNESIA, IF IT WORKS AND USED IN MODERATION, I'M FINE WITH IT.
>> YEAH. SOME PATIENTS CAN'T REALLY CHOKE IT DOWN OVER TIME EITHER.
I LOVE PATIENTS -- I WOULD LOVE THEM TO TAKE MIRALAX, I THINK THAT'S A VERY SAFE
LAXATIVE AND THE PERSON CAN TITRATE THAT DOSE UP AND DOWN VERY SAFELY AS WELL.
IT'S OVER THE COUNTER. SO, THERE ARE A LOT OF OTHER OPTIONS, BUT I AGREE WITH TIM. IT'S FINE.
>> MIRALAX IS THE ONE THAT THE MEDICAL LETTER DEFINITELY SAYS, THIS IS THE FIRST THING, MIRALAX, MIRALAX, MIRALAX.
>> IT'S A WONDERFUL THING. IT'S KIND OF LIKE THE STUFF WE GET FOR COLONOSCOPY, ONLY A
SMALLER AMOUNT, IT LUBRICATE, DOESN'T GET ABSORBED, IT DOESN'T STIMULATE, LUBRICATE THE LARGE INTESTINE.
>> IT DOESN'T LEAVE A MESS. FOR A GUY WHO'S BEEN HAVING A LITTLE PROBLEM WITH HIS -- MY RADIATION, I GET A LITTLE
CONSTIPATION AND MIRALAX IS THE ANSWER. AND STOOL SOFTENER.
>> I THINK WITH ALL OF US, MIRALAX IS THE GO-TO AT THIS POINT IN TIME.
>> HOW ABOUT THIS QUESTION. MY HUSBAND HAS PARKINSON'S AND COPD.
THOSE ARE NOT G.I. TRACT DISEASES. BUT AT THE END OF THE MEAL,HE'LL START TO CHOKE ON MUCUS.
WHERE DOES THE MUCUS COME FROM AFTER HE EATS A BIG MEAL?
>> WELL, WITH PARKINSON'S DISEASE, YOU CAN -- IT'S A MOVEMENT DISORDER, RIGHT?
AND IT AFFECTS THE NEUROLOGIC SYSTEM. AND PART OF THAT CAN AFFECT THE COORDINATION OF THE
ESOPHAGUS, WHICH WE'VE TALKED ABOUT EARLIER. AND, SO, WE WILL SEE SWALLOWING PROBLEMS.
USUALLY PATIENTS WILL TELL US, IT'S NOT JUST SOLIDS, IT'S LIQUIDS AND SOLIDS.
THE MUCUS IS -- WHEN WE EAT, THERE'S A STIMULATION OF SALIVA, NUMBER ONE, THAT HELPS
TO BREAK DOWN FOOD, BREAK DOWN PROTEIN, AND THEN WE SWALLOW AND THEN, OF COURSE, YOU GET
THE INCREASED ACID SECRETION.
SO, I THINK THE MUCUS THAT THE VIEWER'S TALKING ABOUT IS THE COMBINATION
OF THAT INCREASED SALIVARY INPUT WITH THE FOOD.
THAT IS UNABLE TO BE CLEARED EFFECTIVELY AND, SO, THEY'RE FEELING LIKE THEY'RE CHOKING ON THIS MATERIAL.
>> YEAH.
>> AGREE.
>> OR THERE COULD BE SOME ASPIRATION AND IT'S IRRITATING UPPER AIRWAY AND THERE'S MUCUS THERE, TOO.
>> YES, COULD BE COMING FROM THE UPPER RESPIRATORY.
>> THERE WAS SOME QUESTIONS ON MY RADIO SHOW YESTERDAY THAT WAS TRIGGERED.
ONE QUESTION WAS, I TAKE PANTOPRAZOLE, WHICH IS LIKE PRILOSEC, IT'S A PROTON PUMP
INHIBITOR, CAN I GET OFF AFTERA YEAR?
BEEN ON IT FOR A YEAR. DO YOU NEED TO TAPER IT? AND CAN I GET OFF OF IT?
>> SURE. SO YOU CAN DEFINITELY TRY TO HAVE KIND OF A STEP-DOWN THERAPY.
I THINK THERE'S BEEN A LOT OF PRESS LATELY ABOUT THESE MEDICATIONS, CLASS OF
MEDICATIONS CALLED PROTON PUMP INHIBITORS, WHERE THEY'VE MADE THE 5:30 NEWS AND YOU SEE, OH,
NO, THESE MEDICINES MIGHT BE RELATED TO HEART DISEASE, THEY MIGHT BE RELATED TO KIDNEY
DISEASE OR THE LAST ONE WAS ALZHEIMER'S EVEN.
SO THERE'S A LOT OF FEAR ABOUT THESE MEDICATIONS AND POSSIBLE LONG-TERM CONSEQUENCES.
SO, WE DON'T HAVE A BLANKET STATEMENT, SAYING, TAKE EVERYONE OFF.
HOWEVER, IF YOUR REFLUX SYMPTOMS ARE CONTROLLED, YOU'RE DOING WELL, YOU CAN DEFINITELY TRY TO STEP DOWN.
IT CAN BE CHALLENGING, HOWEVER, BECAUSE WHEN YOU ARE TRYING TO COME OFF OF THESE MEDICATIONS, YOU GET THIS KIND
OF REBOUND EFFECT WHERE THERE'S EVEN MORE ACID PRODUCTION.
SO I TELL MY PATIENTS, USE THE GOOD OLD-FASHIONED MEDICATION, ZANTAC WHILE YOU'RE COMING OFF
AND IF YOU ONLY HAVE THE INTERMITTENT REFLUX A FEW TIMES PER WEEK, STICK WITH ZANTAC, IT'S CHEAP, IT'S VERY SAFE AS WELL.
>> I LIKE THE IDEA OF TAPERING IT, ALTHOUGH I HEARD THE TAPER SOMETIMES TAKES THREE MONTHS IF YOU'RE GOING TO TAPER OFF.
>> I THINK THE KEY POINT, AND SHE JUST HIT IT ON THE HEAD,
THESE MEDICATIONS ARE VERY GOOD FOR INDIVIDUALS THAT NEED THEM.
BUT MANY TIMES, THEY MAY BE GIVEN THIS MEDICATION, AND IT'S NEVER ADDRESSED AGAIN, AND PATIENTS THINK THEY --
>> STAY ON. AND THEY CAN'T GET OFF OF IT BECAUSE THEY HAVE REFLUX.
>> EXACTLY. SO IT BEHOOVES THE PHYSICIAN THAT PRESCRIBES IT TO MONITOR
THESE PEOPLE BECAUSE MANY OF THEM DON'T NEED IT LONG TERM. OTHERS DO.
YOU HAVE TO SEPARATE THOSE TWO.
I STILL SAY IF I HAVE TO TAKE A MEDICINE LONG TERM, IF I NEED IT, IT'S ONE OF THE SAFER ONES YOU CAN TAKE.
>> RIGHT, RIGHT. I THINK ALL OF THIS ABOUT THE DANGER IS REALLY BLOWN UP, THE 5:00 NEWS STORY.
>> YES.
>> BUT C DIFFICILE, OVERGROWTH IS ANOTHER THING THAT THEY'RE FINDING, ISN'T IT, ASSOCIATION.
>> ABSOLUTELY.
>> HOW MUCH OF AN ASSOCIATION? WHEN YOU'VE GOT A DRUG THAT REALLY WORKS.
BUT REALIZE THAT IF YOU'RE TAPERING IT, YOU GOT TO TAPER IT OVER A LONG PERIOD OF TIME, GRADUALLY, SKIP EVERY THIRD
NIGHT, SKIP EVERY OTHER FOR A WHILE, THEN SKIP, YOU KNOW, THAT TYPE OF THING.
>> EXACTLY.
>> OKAY. WE GOT ONE MORE QUESTION HERE. I HAVE AN AUNT DIAGNOSED WITH CROHN'S DISEASE.
WHAT IS THAT AND HOW IS IT TREATED?
>> SO, CROHN'S DISEASE IS A DISORDER THAT CAN AFFECT PATIENTS FROM MOUTH TO ANUS,
IT CAUSES ULCERATION, INFLAMMATION, USUALLY THIS A PATCHY FASHION AND IN SOME
INDIVIDUALS IT CAN AFFECT SMALL BOWEL ONLY OR ONLY THE COLON.
MOST ARE WITHIN THE COLON AND SMALL BOWEL, THAT COMBINATION AS WELL.
IT CAUSES BLOODY DIARRHEA AND ABDOMINAL PAIN. THIS IS GENETIC.
WE KNOW THAT OVER 126 GENES THAT CAN CAUSE OR ARE RELATED TO CROHN'S DISEASE.
>> CAN IT BE WITHOUT GENETICS? I MEAN, NO ONE ELSE HAD CROHN'S DISEASE IN MY FAMILY.
>> YUP, YUP, ABSOLUTELY, IT CAN BE SPONTANEOUS AS WELL. AND, YES, PEOPLE NEED
TREATMENT FOR IT LONG TERM, THERE CAN BE A SLIGHTLY HIGHER RISK OF COLON CANCER IF
CROHN'S IS IN THE COLON. SO PEOPLE NEED TO BE ON TREATMENT LIFE LONG FOR THIS.
>> SO, SOME PEOPLE, I MEAN, IT'S THAT -- INSTEAD OF ULCERATIVE COLITIS THAT STARTS AT THE ANUS AND KIND OF
DESCENDS, IT CAN BE SPOTTY, ALL OVER THE PLACE, INCLUDING THE SMALL INTESTINE.
IT SEEMS TO BE A TOUGHER DISEASE THAN ULCERATIVE COLITIS.
>> I WOULD AGREE WITH THAT STATEMENT. BUT I'M A PHYSICIAN, TOO,
WELL, THE COLON IS JUST THE PROBLEM WITH ULCERATIVE COLITIS, YOU CAN ALWAYS CUT IT OUT.
WITH CROHN'S, IF YOU CUT OUT THE SEGMENT OF INFLAMED LINING, YOU PUT THAT PIECE BACK TOGETHER, THAT DISEASE
WILL COME RIGHT BACK AT THE EXACT SAME SITE.
AND OVER TIME IT CAN BE A REALLY HORRIBLE SITUATION.
>> TOUGH DEAL.
>> CROHN'S DISEASE W UNOF THOSE -- IS ONE OF THOSE DISORDERS THAT WE ARE PRIMARY
CAREGIVERS FOR THEM BECAUSE YOU NEVER CURE THEM, IF YOU WORK WITH THEM, YOU CAN GIVE THEM A GOOD QUALITY OF LIFE.
WE AS G.I. DOCS, A LOT OF THE PATIENTS I REMEMBER THROUGH THE YEARS WERE MY CROHN'S
PATIENTS BECAUSE YOU LIVE WITH THEM, YOU'VE SUFFERED WITH THEM.
AND YOU WORK THROUGH IT. BUT MOST OF THEM, YOU CAN GET WHERE THEY HAVE A GOOD QUALITY OF LIFE.
>> HAVE THE BIOLOGICS, YOU KNOW, THE NEW ANTIRHEUMATOLOGY DRUGS BEEN A GODSEND? I MEAN, THEY'VE SAVED --
>> THEY'VE BEEN WONDERFUL. I WONDER HOW WE DID BEFORE WE HAD THEM.
I CAN REMEMBER WHEN THE FIRST ONE CAME OUT. AND EVERYONE'S LIKE, OH, MY
GOSH, IT'S A MIRACLE. WELL, IT WORKS WELL, BUT, YOU KNOW, THESE MEDICINES HAVE THEIR OWN ISSUES. YOU KNOW? AND, SO, --
>> AND THEY'RE NOT CHEAP.
>> AND THEY'RE NOT CHEAP.
>> NO, NOT AT ALL.
>> BUT, ON THE OTHER HAND, THEY HAVE GIVEN PEOPLE THEIR LIVES BACK IN MANY INSTANCES.
>> ONE OF THE BEST WAYS TO WATCH FOR PROBLEMS IN THE G.I. TRACT IS TO JUST GO AND LOOK.
>> WE USUALLY START SCREENING AT 50 YEARS OLD FOR PEOPLE WHO DON'T HAVE ANY SYMPTOMS AND DON'T HAVE ANY FAMILY HISTORY.
FAMILY HISTORY OF COLON CANCER, WE USUALLY RECOMMEND, IF IT'S IN THE FIRST-DEGREE RELATIVE, WE WOULD RECOMMEND EVERY FIVE YEARS.
DIAGNOSTIC COLONOSCOPIES, AS WELL AS SURVEILLANCE. SURVEILLANCE IS WHEN IT'S LESS
THAN FIVE YEARS, SO THEY'VE HAD SOMETHING, SUCH AS COLON CANCER OR COLON POLYPS THAT NEED TO BE MONITORED.
AND THEN A DIAGNOSTIC COLONOSCOPY IS FOR PEOPLE WHO HAVE HAD PROBLEMS SUCH AS BLOOD IN THEIR STOOLS, BLACK,
TARRY STOOLS, CHANGE IN THEIR BOWEL HABITS, ABDOMINAL PAIN, DIVERTICULITIS, SOMETHING LIKE
THAT, THAT MAKES -- THERE'S SOMETHING SPECIFIC THAT WE'RE GOING IN TO LOOK FOR.
ABNORMALITIES CAN BE ANYTHING FROM MASSES TO POLYPS, AS WELL AS DIVERTICULI, HEMORRHOIDS, I
WOULD SAY, EVEN THOUGH THEY'RE REALLY REALLY COMMON, THEY ARE STILL AN ABNORMALITY.
THERE'S ALSO MALFORMATIONS, MEANING ABNORMAL CONNECTIONS BETWEEN BLOOD VESSELS, I'VE
FOUND, ACTUALLY, LYMPHOID THAT LOOK LIKE POLYPS BUT WE STILL REMOVE THEM ANYWAY BECAUSE WE
CAN'T TELL JUST BY THE NAKED EYE, NECESSARILY.
ANY BLOOD IN THE STOOLS SHOULD NOT BE IGNORED BECAUSE NO MATTER WHAT AGE YOU ARE, COLON
CANCER CAN OCCUR AT ANY AGE, AND I KNOW OF
30-SOME-YEAR-OLDS WHO HAVE DIED BECAUSE, YOU KNOW WHAT, THEY JUST THOUGHT IT WAS HEM OTHERWISE.
BIGGEST DETERRENT FOR PEOPLE NOT HAVING COLONOSCOPIES IS REALLY THE PREP. HEMORRHOIDS.
WHENEVER I TALK TO A PERSON, THEY SAY, I DON'T WANT TO DO THAT PREP.
THE PREP LASTS A NIGHT. AND, YES, IT IS NOT FUN. BUT THE THINGS THAT WE CAN
PREVENT FROM DOING ONE PREP IS, I MEAN, WE CAN SAVE LIVES DOING COLONOSCOPIES.
YOU CAN GO THROUGH THE PREP, HAVE A COLONOSCOPY, TAKE OFF POLYPS THAT CAN GO INTO CANCER
AND THAT CAN PREVENT YOU FROM HAVING TO HAVE A SURGERY.
WHICH WOULD DECREASE YOUR TIME AT WORK AND YOU STILL NEED TO GO THROUGH A PREP THEN.
>> WELL, WE HAD TO WRESTLE THAT POOR PATIENT IN TO AGREEING TO LET US DO HER COLONOSCOPY.
OH, IT WAS JOANIE, MY WIFE. THANK YOU, JOANIE, FOR WILLING TO DO THAT AND DR. OEY, WHO WAS THE SURGEON.
COLONOSCOPY IS AN ISSUE AND I THINK WE SHOULD TOUCH BASE ON COLONOSCOPIES.
IT IS NOT THAT BAD OF A THING. MOST OF US GET ANESTHESIA, YOU DON'T REMEMBER ANY OF IT, IT'S JUST THE PREP.
WHAT'S YOUR TAKE ON IT?
>> I TELL MY PATIENTS, THE WORST PART WILL BE THE PREP, AND YOU WILL NOT REMEMBER A THING ABOUT THE PROCEDURE ITSELF.
AND, SO, IF MAKE IT THROUGH DRINKING A GALLON, HALF GALLON, NOW EVEN A TWO-CUP PREP,
YOU KNOW, IT'S SUCH AN IMPORTANT THING AND A LIFE-SAVING PROCEDURE AS WELL.
>> THIS IS COLORECTAL CANCER AWARENESS MONTH.
>> OH, IT IS?
>> AND THE THING IS, EVERYONE HEARS ABOUT COLONOSCOPY AND SCREENING, THIS IS THE ONE
CANCER WE CAN CATCH BEFORE IT'S CANCER. I ALWAYS TELL PATIENTS, WITH MAMMOGRAMS, YOU KNOW,
MAMMOGRAMS ARE VERY POPULAR, THEY'RE VERY GOOD. BUT THEY'RE DESIGNED TO PICK UP CANCER.
WITH COLONOSCOPY, IT'S THE POLYP, THE GROWTH THAT CAN LEAD TO CANCER.
NOW, SOME OF OUR VIEWERS MAY SAY, NOT IN MY LIFE AM I GOING TO GET THAT DONE.
AN ALTERNATIVE, AND YOU MENTIONED IT ON YOUR QUIZ, IS CHECKING THE STOOL FOR BLOOD.
WE HAVE A NEW TEST CALLED A FID, IMMUNOCHEMICAL TEST, IT'S VERY SPECIFIC.
THE ISSUE IS, THOUGH, IF THAT STOOL TEST COMES BACK POSITIVE, THEN YOU NEED A COLONOSCOPY.
BUT IF IT'S NEGATIVE, YOU'RE OFF THE HOOK. AND AT LEAST YOU'VE BEEN SCREENED IN SOME FASHION.
AND WE KNOW THAT EVEN THAT WILL SAVE LIVES.
>> YEAH.
>> AND IN THE STATE OF SOUTH DAKOTA, 50% OF PEOPLE HAVE NOT -- WHO NEED A COLONOSCOPY
OVER THE AGE OF 50 HAVE NOT HAD A SCREENING COLONOSCOPY. WE ARE DEFICIENT.
>> WE'RE SHOOTING FOR 80% BY 2018.
>> BUT WE HAVE ONLY 50% OF HAVE HAD THEIR COLONOSCOPIES.
THIS IS A CALL-OUT FOR THOSE OF YOU WHO HAVE NOT. PLEASE DO.
I HAD A DEAR FRIEND WHO HAD A COLONOSCOPY. I DID IT.
FOUND A POLYP. TIME TO DO ANOTHER COLONOSCOPY.
I DON'T WANT TO DO THAT AGAIN. I DON'T WANT TO DO IT. OH, COLON CANCER SPREAD. AND IT KILLED HIM.
PLEASE, YOU KNOW, IT KILLED MY FATHER. GET IT DONE. WE TALKED ABOUT CROHN'S DISEASE.
HERE IS THIS ABOUT PRESBIA ESOPHAGUS, OLDER ESOPHAGUS, HAS NOTHING TO DO WITH THE PRESBYTERIAN CHURCH, RIGHT?
A WOMAN FROM -- [ Laughter ]
A WOMAN FROM IOWA HAS PROBLEMS SWALLOWING AND WAS TOLD THAT THE OPENING OF THE STOMACH WAS FINE BUT THAT SHE HAS A
SPASTIC ESOPHAGUS, MANAGES IT BY BEING CAREFUL TO NOT DRINK VERY COLD BEVERAGES AND
CHEWING SLOWLY MAKES IT EASIER. ARE THERE OTHER SUGGESTIONS TO TREAT PRESBYESOPHAGUS?
>> IT'S A DIFFICULT ONE TO TREAT.
BUT, FIRST OF ALL, YEAH, THE EXTREME TEMPERATURES CAN CAUSE SPASMS THAT CAN CONTRIBUTE.
NOW, IN SOME INDIVIDUALS, IF THAT ESOPHAGUS IS TRULY SPASMING, THERE ARE RELAXANTS THAT YOU CAN GIVE, NOT
SEDATIVES, BUT THESE ARE MUSCLES THAT RELAX, -- THESE ARE MEDICINES THAT RELAX
SMOOTH MUSCLE, WHICH IS WHAT THE ESOPHAGUS IS MADE OF.
AND IN SOME INDIVIDUALS THAT CAN BE OF BENEFIT.
OCCASIONALLY PASSING A STRETCHER TUBE, A DILATER ACROSS THE ESOPHAGUS MIGHT GIVE BENEFIT. BUT THERE IS NO --
>> REAL GOOD ANSWER.
>> -- EASY FIX. I THINK THE VIEWER IS DOING A GOOD THING.
THE BEST THING AND THE SAFEST THING, THAT IS AVOIDING THINGS THAT GIVE HER TROUBLE.
EXTREME TEMPERATURE FOODS AND JUST DRINKING SLOWLY AND EATING SLOWLY.
AND, REALLY, THAT'S AS GOOD AS IT GETS.
>> WHAT'S THE NAME OF THE MEDICINE?
ANTISPASMODIC LIKE VENTAS, STUFF LIKE THAT.
>> EVEN NITRATES CAN HELP.
>> GOOD OLD-FASHIONED NITROGLYCERIN CAN BE A BENEFIT IN A SMALL AMOUNT OF PEOPLE.
>> ALL RIGHT. MY HUSBAND, 88 YEARS OF AGE, IN 1996 HAD SURGERY FOR COLON
POLYPS BUT DIDN'T HAVE CANCER. SINCE THEN HE'S HAD COLONOSCOPIES PERIODICALLY. HE'S 88 NOW.
DO YOU THINK HE STILL SHOULD HAVE A COLONOSCOPY?
>> THAT'S A GREAT, GREAT QUESTION.
AND IT'S SOMETHING THAT REALLY WE'VE LOOKED AT EXTENSIVELY. BECAUSE YOU GET TO A POINT
WHERE YOU HAVE TO ASK YOURSELF, WHAT IS THE RISK OF GETTING ANOTHER CANCER VERSUS THE RISK OF THE PROCEDURE?
NOW, CRISTY SAID, IT'S A VERY SAFE PROCEDURE.
BUT AS WE GET OLDER, THINGS CAN HAPPEN. THE GENERAL GUIDELINE IS UP TO AGE 85.
AND DEPENDING ON THE HISTORY, AND WHAT'S BEEN -- AT THAT POINT YOU HAVE TO START HAVING
THAT CONVERSATION WITH THE PATIENT AND SAY, HERE'S THE RISKS, HERE ARE THE BENEFITS.
AT AGE 88, IF HE DIDN'T HAVE MANY POLYPS IN THE PREVIOUS FIVE OR TEN YEARS, I WOULD
PROBABLY SAY, WE'RE DONE. THAT'S A HARD THING TO DO, ISN'T IT?
BECAUSE DOCTORS DON'T WANT THEIR PATIENTS TO GET CANCER BUT IT'S THE RIGHT THING TO DO.
>> ALSO, YOU HAVE TO THINK, IF YOU FIND A CANCER IN AN 88-YEAR-OLD, WILL HE OR SHE BE ABLE TO WITHSTAND SURGERY.
SO, YOU KNOW, IT'S VERY -- VERY TOUGH DECISION.
>> SO, IN MEDICINE, OUR ATTEMPTS TO DO WELL WITH PEOPLE, SOMETIMES WE CAN HARM.
AND I THINK THIS IS AN INSTANCE WHERE AT AGE 88, IF IT WERE ME, I'D SAY WE'RE DONE.
>> HE WAS IN HIS 80s, IT WAS 1980 SOMETHING, HE WAS IN MY OFFICE, HIS DAUGHTER WAS
THERE, AND I HAD DONE A HEMOCCULT THAT WAS POSITIVE.
WE ENDED UP WITH A BARIUM ENEMA, THERE IT WAS, AN APPLE CORE LESION.
IN OTHER WORDS, IT LOOKED LIKE, YOU KNOW, IT WAS COMING ALONG THIS WAY, THEN IT TURNED
INTO AN APPLE CORE, IN OTHER WORDS, THERE WAS A STRICTURE, SO IT LOOKED LIKE IT WAS CANCER.
AND IT WAS, I'M SURE IT WAS. AND IT WAS RIGHT IN THE MIDDLE OF THE TRANSVERSE COLON.
AND, I HAD, YOU'RE 88 YEARS OF AGE. AND, YOU KNOW, YOU'RE VIABLE
AND YOU'RE TALKING WITH ME AND YOU MAKE SENSE AND YOU HAVE A NORMAL LIFE.
I WOULD RECOMMEND THAT WE HAVE IT REMOVED. SURGICALLY.
AND HE SAID, NOT IN YOUR LIFETIME.
NO WAY. I'M NOT GOING TO HAVE IT DONE. AND HE DIED AT 94 OF A HEART ATTACK OR HEART FAILURE,
SOMETHING, IT WASN'T THE COLON CANCER.
EVEN THOUGH ADVANCED, BECAUSE WHEN YOU'RE 88, SOMETIMES THOSE CANCERS ARE ALSO 88.
THAT WAS A STORY. NOT TO SAY THAT WE SHOULDN'T DO COLONOSCOPIES AND TO RESECT THOSE CANCERS, BUT WHEN YOU
GET OLDER, THERE'S A TIME TO --
>> THERE'S A TIME TO BE DONE AND SOMETIMES THE TREATMENT CAN BE WORSE THAN THE UNDERLYING PROBLEM.
>> THAT'S RIGHT. IS THERE A DIFFERENCE BETWEEN MICROSCOPIC COLITIS AND COLITIS?
>> SURE. SO COLITIS JUST MEANS INFLAMMATION OF THE LINING OF THE COLON.
IT CAN BE DUE TO INFECTION, IT CAN BE DUE TO INFLAMMATORY BOWEL DISEASE LIKE ULCERATIVE COLITIS.
WHAT IS MICROSCOPIC COLITIS? ABOUT 20 YEARS WE FIGURED OUT WHAT MICROSCOPIC COLITIS IS.
THESE ARE INDIVIDUALS WHO STRUGGLE WITH DIARRHEA AND WHEN YOU LOOK AT THE LINING OF THE COLON, IT'S COMPLETELY
NORMAL BUT YOU TAKE THE BIOPSIES AND LOOK UNDERNEATH THE MICROSCOPE AND THEN YOU INFLAMMATION IN A NEW SUBSETS.
>> WHAT DO YOU DO FOR IT?
>> SO YOU CAN START WITH A FEW MEDICATIONS. THE FIRST AND FOREMOST IS KIND OF A LOW-DOSE STEROID CALLED
BUDESONIDE AND IT WILL DECREASE THE INFLAMMATORY CELLS.
IT'S AMAZING, THE DIARRHEA, WITHIN 24, 48 HOURS STOPS.
>> SO YOU TREAT IT KIND OF LIKE ULCERATIVE COLITIS.
>> YOU CAN. YEAH. YOU CAN USE PEPTO BISMOL. YOU COULD USE OTHER
MEDICATIONS ALSO TO TREAT ULCERATIVE COLITIS AS WELL.
>> PEPTO BISMOL. WHAT DO YOU DO WITH AN INFECTIOUS DIARRHEA?
A PERSON COMES BACK FROM MEXICO AND THEY'VE GOT DIARRHEA FROM THE MEXICAN EXPERIENCE.
VERSUS A PERSON WHO ATE RAW HAMBURGER BECAUSE THEY REALLY LIKE RAW HAMBURGER AND THEY
LIKE RAW MEAT, RARE MEAT, AND THEY GOT INFECTIOUS DIARRHEA, VERSUS A PERSON WHO JUST CAME
ON A BOAT, ON A CRUISE SHIP AND GOT DIARRHEA, THOSE ARE THREE KIND OF DIFFERENT? COULD YOU EXPLAIN THOSE?
>> WELL, THERE'S DIFFERENT FORMS OF INFECTIOUS DIARRHEA. SOME CAN BE VERY SERIOUS. OTHERS NOT.
RAW HAMBURGER ONE IS THE ONE YOU WORRY ABOUT THE MOST.
>> YES.
>> THERE'S AN ORGANISM THAT CAN BE TRANSMITTED WITH THAT THAT'S VERY SERIOUS CALLED E.
COLI AND IT'S CALLED THE TOXIGENIC VERSION. THESE PEOPLE ARE SICK. THEY COME IN WITH BLOODY DIARRHEA.
AND YOU HAVE TO ADDRESS THAT VERY QUICKLY. AND GIVE THEM SUPPORTIVE CARE. NOT ANTIBIOTICS BECAUSE
SOMETIMES THAT CAN MAKE IT WORSE AND THEN THEY CAN GET COMPLICATIONS SUCH AS RENAL FAILURE AND SO FORTH.
SO, THAT HAS TO BE DIAGNOSED AND SUPPORTED QUICKLY. NOW, THE TRAVELERS DIARRHEA
THAT YOU'RE TALKING ABOUT, VERY COMMON.
>> THE MEXICAN. [ OVERLAPPING CONVERSATION ]
>> MONTEZUMA'S REVENGE. AND THAT IS NOT INVASIVE. MEANING THE LINING OF THE COLON IS NOT INJURED.
YOU USUALLY DO NOT SEE BLOOD. YOU JUST SEE VOLUMINOUS AMOUNTS OF DIARRHEA.
AND THAT CAN BE TREATED. WITH A SHORT COURSE OF ANTIBIOTICS AND THOSE PATIENTS USUALLY DO VERY WELL.
>> OKAY. SO, THAT'S GREAT. THE IMPORTANCE OF THAT INFECTIOUS RAW HAMBURGER THING.
>> WELL DONE.
>> YES. OKAY. SO WE'RE RUNNING OUT OF TIME SO WE NEED TO BE QUICK ON THE NEXT ANSWERS.
NEW TREATMENTS FOR CROHN'S DISEASE IN YOUNGER INDIVIDUALS, LIKE 29.
>> SO, THERE ARE NUMEROUS DIFFERENT TYPES OF WHAT ARE CALLED BIOLOGIC MEDICATIONS
AND THESE ARE INFUSIONS WHICH TARGET A SPECIFIC PART OF THE IMMUNE SYSTEM AND NOW THERE
ARE NEW COUSINS TO THIS CALLED INTEGRIN, ANTI-INTEGRIN FACTORS, SO LOTS AND LOTS OF NEW MEDICATIONS.
AND THESE ARE FOR PATIENTS WITH MODERATE TO SEVERE CROHN'S DISEASE.
>> THIS ONE WANTS TO HAVE CHILDREN.
>> ABSOLUTELY.
>> NO PROBLEM.
>> YUP. IT WILL BE FINE.
>> PLEASE TALK ABOUT THE SPECIFIC PROGNOSIS TREATMENT OPTIONS FOR PEOPLE WITH ESOPHAGEAL VARICES.
>> WHAT ARE THEY? THEY'RE ENLARGED VEINS. WE ALL HAVE SMALL VEINS IN OUR
ESOPHAGUS AND THEY DON'T GIVE US ANY TROUBLE.
BUT WHEN YOU HAVE ISSUES, MOST COMMONLY WITH THE LIVER, WHERE BLOOD THAT'S SHUNTED FROM THE
GUT TO THE LIVER, THE LIVER GETS STIFF AND FIBROTIC, CIRRHOSIS IS ONE OF THE COMMON FORMS.
THAT BLOOD HAS TO FIND AN ALTERNATE ROUTE. AND ONE OF THOSE ROUTES ARE INTO THE SMALL VEINS, WHICH IN
THE ESOPHAGUS WHICH THEN BECOME QUITE ENLARGED. THE BIG RISK THERE IS IF THEY BLEED.
IF THEY RUPTURE. THEN YOU HAVE AN EMERGENCY. SO, WE HAVE TREATMENTS FOR THESE VARICES DEPENDING ON THEIR SIZE.
WE HAVE WAYS TO PREVENT FIRST-TIME BLEEDING, MEDICATIONS THAT CAN BE OF BENEFIT IN THAT.
ALSO, WE CAN GO DOWN, CRISTY, AND I WITH A TELESCOPE AND WE CAN PUT RUBBER BANDS ON THESE
VEINS IN THE LOWER PART OF THE ESOPHAGUS, WHICH HAS ALSO BEEN SHOWN TO PREVENT REBLEEDING.
SO THE ANSWER IS, IT DEPENDS ON THE CAUSE.
YOU HAVE TO DETERMINE THE CAUSE OF THESE VARICES, NUMBER ONE.
THE PROGNOSIS, IF YOU ALLOW THEM TO GET TO THE POINT THAT THEY BLEED, NOT SO GOOD.
BUT IF WE'RE PROACTIVE AND WE GET ON TOP OF THIS QUICKLY AND EARLY,
WE CAN ACTUALLY PREVENT BLEEDING AND CAN HAVE A MUCH BETTER PROGNOSIS.
>> BUT THEN CIRRHOSIS IS ANOTHER STORY. WILL THAT --
>> THEN YOU'VE GOT THE WHOLE LIVER ISSUE, WHICH YOU CAN'T DO ANYTHING ABOUT BY BANGED
THE VARICES, YOU PREVENT THE BLEEDING PART.
>> TOUGH. I HAVE HOARSENESS IN MY VOICE BOX, IT'S NOT CAUSED BY ACID REFLUX. WHAT COULD CAUSE THIS?
SO MY GUESS IS THAT OFTENTIMES PEOPLE HAVE REFLUX,
THEY DON'T THINK THEY HAVE REFLUX, BUT THE HOARSENESS IS DUE TO REFLUX.
BUT IT COULD BE DUE TO CANCER, IT COULD BE DUE TO SMOKING, IT COULD BE A LOT OF OTHER THINGS.
>> POST NASAL DRIP.
>> POST NASAL DRIP. BUT TALK ABOUT ACID REFLUX QUICKLY AS A CAUSE OF HOARSENESS.
>> ACID REFLUX CAN COME ALL THE WAY UP TO THE BACK OF THE THROAT.
THEN IT'S LIKE A FINE SPRAY NOZZLE AND LITTLE DROPS OF ACID, SOMETIMES EVEN NONACID
WILL LAND ON THE VOCAL CHORDS AND ATTACK, LPR, IT'S KIND OF A CONTENTIOUS AREA BECAUSE WE
DON'T REALLY KNOW IF ALL THOSE PATIENTS WHO ARE DIAGNOSED WITH IT REALLY HAVE IT OR NOT.
BUT SIMPLY HAVE A TRIAL OF A PROTON PUMP INHIBITOR FOR EIGHT WEEKS.
>> OVER THE COUNTER.
>> EIGHT WEEKS.
>> TWO MONTHS.
>> YUP. AND SEE.
>> AND THE KEY IS, IF YOU'RE GOING TO DO THAT, IT HAS TO BE EFFECTIVE DOSING.
WE TOO OFTEN GIVE SMALL DOSES, AND TO REALLY DETERMINE IF IT'S EFFECTIVE, IT SHOULD BE A HIGHER DOSE.
>> 40 MILLIGRAMS.
>> FOR TWO TO THREE MONTHS AS A TRIAL. AND IF THEY DON'T RESPOND, CHANCES ARE IT'S NOT.
>> IT'S NOT IT.
>> ENDOSCOPY IN THOSE INSTANCES, NOT HELPFUL. WE JUST RARELY WILL SEE ESOPHAGEAL INJURY IN THOSE PATIENTS.
>> I AGREE.
>> BUT ALSO THE OTHER CAUSES OF HOARSENESS, CAN BE CANCER OF THE -- [ OVERLAPPING CONVERSATION ]
>> THE EVALUATION IS CRITICAL. EAR, NOSE AND THROAT SHOULD TAKE A LOOK IN THERE AND MAKE SURE.
>> ABSOLUTELY. SEEMS TO HAVE A LEAKY BOWEL FROM THE MORNING AND INTO THE AFTERNOON.
IS THERE ANYTHING THAT CAN BE DONE FOR THIS?
IS THERE AN EXPLANATION AS TO WHY THIS IS OCCURRING? SO, I'M PROBABLY RECTAL LEAKING.
>> THAT'S WHAT I'M THINKING, YEAH.
>> AND I THINK -- THAT'S ONE REASON I DON'T RECOMMEND HEMORRHOIDAL SURGERY BECAUSE
ONCE YOU START MESSING AROUND WITH THAT KIND OF FLOPPY LOOSE TISSUE THAT FALLS AND PREVENTS LEAKING,
YOU GET SCAR TISSUE AND THEN YOU DON'T HAVE --
>> YOU LOSE TONE. 10% OF WOMEN WHO DELIVER VAGINALLY WILL END UP WITH FECAL INCONTINENCE.
WE DON'T TALK ABOUT THAT EITHER. SO IT IS A COMMON THING, BULK UP STOOLS, SLOW DOWN, YOU
KNOW, THE STOOLS, YOU ALSO WANT TO EAT HEALTHIER FOODS, YOU DON'T WANT TO BE EATING
THE GREASY FAST FOODS, FATTY FOODS THAT CAN ZIP RIGHT THROUGH YOU.
>> AND THEN IF YOU NEED A DEPENDS, THEN YOU NEED A DEPENDS, NO BIG DEAL.
DON'T FEEL THAT YOU HAVE TO STAY AT HOME. GET OUT AND GET AMONG THE PEOPLE.
WE'VE GOT TO LET THOSE THINGS -- FORGET ABOUT IT.
HAD A COLONOSCOPY A YEAR AGO AND THEY FOUND TWO BENIGN POLYPS, I WAS TOLD TO COME BACK IN FIVE YEARS.
HAS A FAMILY HISTORY OF COLON CANCER.
IS WONDERING IF FIVE YEARS IS PERHAPS TOO LONG TO WAIT FOR ANOTHER SCREENING?
>> NO, IT'S NOT. WE HAVE THE ADVANTAGE OF MILLIONS OF COLONOSCOPIES TO LOOK AT OVER A PERIOD OF TIME
TO UNDERSTAND APPROPRIATE FOLLOW-UP. FOR THESE INDIVIDUALS. AND THESE GUIDELINES
ARE PRETTY GOOD AND THEY'RE BASED ON A LOT OF EVIDENCE.
SO, IF SOMEONE HAS TWO OR LESS POLYPS THAT ARE SMALL, BENIGN, THEN IT'S RECOMMENDED THAT I HAVE FIVE-YEAR FOLLOW-UP.
THE FAMILY HISTORY OF COLON CANCER, YOU NEVER WANT TO GO LONGER THAN FIVE YEARS.
THE OTHER THING WITH FAMILY HISTORY THAT'S IMPORTANT TO UNDERSTAND, IF YOU'VE HAD A
FIRST-DEGREE RELATIVE THAT WAS DIAGNOSED AT AGE 75 OR 80, WE DO NOT THINK THAT THAT
INCREASES YOUR RISK ALL THAT MUCH.
IT'S WHEN YOUR RELATIVE WAS DIAGNOSED UNDER THE AGE OF 60.
THOSE ARE THE PEOPLE THAT HAVE THE SUBSTANTIAL INCREASED RISK AND YOU WANT TO DO -- BUT I
THINK, IN THAT SITUATION, I WOULD THINK FIVE YEARS WOULD BE REASONABLE.
>> FIVE YEARS WOULD BE VERY APPROPRIATE.
>> BUT YOU COULD CHECK THE STOOL FOR BLOOD ONCE A YEAR. MY PERSONAL ANALYSIS, I DO THAT ON EVERYONE EVERYWHERE,
DO THE OLD-FASHIONED RECTAL EXAM, I KNOW THERE'S BETTER AND MORE SENSITIVE TESTS.
BUT, BOY, IF THEY'VE GOT THAT, THEY GET A COLONOSCOPY FROM ME, I DON'T CARE.
SO IF YOU SEE BLOOD IN YOUR STOOL, YOU CERTAINLY WANT TO GET IT DONE SOONER.
>> DON'T IGNORE IT.
>> DON'T IGNORE IT.
>> FATHER AND BROTHER DIED FROM ESOPHAGEAL CANCER. IS THERE SOMETHING THE FEMALE MEMBERS OF THE FAMILY SHOULD BE WORRIED ABOUT?
>> WELL, THANKFULLY WOMEN ARE NOT AS HIGH RISK FOR ESOPHAGEAL CANCER.
NOW, WHEN AN INDIVIDUAL HAS TWO FAMILY MEMBERS, YOU COULD SAY SCREENING OR LOOKING INSIDE THE ESOPHAGUS STARTING
AT AROUND AGE 50 WOULD BE APPROPRIATE.
BUT WE SEE ESOPHAGEAL CANCER 60-YEAR-OLD WHITE MEN WHO SMOKE AND DRINK.
IT'S VERY RARE FOR WOMEN TO HAVE ESOPHAGEAL CANCER.
>> ESOPHAGUS, I TELL EVERYONE, IF YOU SEE A WOMAN WITH BARRETT'S, I QUESTION THE DIAGNOSIS. IT'S THAT RARE.
>> SO MEN ARE THE ONES. AND ONE MORE REASON NOT TO SMOKE.
>> ABSOLUTELY.
>> WOW. I HAVE HAD REFLUX AND I HAVE BEEN ON A PROTON PUMP INHIBITOR FOR A LONG TIME.
I RECENTLY READ THAT PROTON PUMP INHIBITORS ARE RELATED TO RISKS OF DEMENTIA AND SO ON.
YOU WOULD SAY VERY MINIMAL DATA?
>> AND YOU HAVE TO REALIZE THAT THESE ARE ALL JUST ASSOCIATIONS.
AND IT'S LOOKING AT MILLIONS OF PATIENTS THAT HAVE TAKEN THESE DRUGS AND THE NUMBERS
OF PEOPLE THAT THEY'RE MAKING THIS ASSOCIATION IS VERY SMALL.
MY ADVICE IS, IF YOU NEED THAT MEDICINE, TAKE IT. IF YOU DON'T NEED IT, YOU CAN TRY TO GET OFF IT. COMMON-SENSE APPROACH.
>> RIGHT. HAD PROBLEMS WITH DIVERTICULITIS.
WE GOT 30 SECONDS, STOMACH RUPTURED WHEN SHE WAS YOUNGER. HAD A TOTAL OF SIX OPERATIONS. NOW HAS GASTROPARESIS
FOR ABOUT FOUR YEARS, VERY MISERABLE, DISCUSS TREATMENTS OF GASTROPARESIS.
>> PARALYSIS, SWELLING OF THE STOMACH, STOMACH EMPTYING, TREATMENT, DIET, LOW FAT,
FIBER, LIQUIDS ARE BETTER THAN SOLIDS.
THERE ARE A FEW MEDICATIONS BUT THEY ALSO HAVE SIDE EFFECTS AS WELL.
EXTREME CASES, SOMEONE'S LOSING WEIGHT, WE CAN TALK ABOUT FEEDING TUBES AS WELL.
>> FEEDING TUBES TO KEEP THEIR -- KEEP THEM ALIVE.
>> WE JUST DON'T HAVE REAL GOOD SAFE MEDICINES FOR THAT. THAT IS A TOUGH ONE TO DEAL WITH.
>> TOUGH.
>> AND NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
PICK THE BEST ANSWER. SCREENING FOR COLORECTAL CANCER:
A. SHOULD BEGIN AT AGE 40? YES? NO.
A LITTLE EARLY. UNLESS THERE'S FAMILY HISTORY.
>> UNLESS THERE'S A FAMILY HISTORY.
>> B. AT BARE MINIMUM SHOULD INVOLVE CHECKING THE STOOL FOR BLOOD YEARLY AFTER THE AGE OF 50?
SOUNDS PRETTY GOOD, DOESN'T IT?
>> SOUNDS PRETTY GOOD TO ME.
>> C. INVOLVES HAVING A COLONOSCOPY EVERY FIVE YEARS STARTING AT AGE 55? NOT SOON ENOUGH.
AND THE BEST ANSWER IS B! CHECKING THE STOOL FOR BLOOD YEARLY AFTER AGE 50.
OR AN EVEN BETTER OPTION IS GETTING A FULL COLONOSCOPY EVERY TEN YEARS AFTER THE AGE OF 50.
IT WAS HOLLY ROGERS FROM ABERDEEN WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU, HOLLY, FOR PARTICIPATING. A BOOK WILL BE IN THE MAIL TO YOU SOON.
WE'LL BE RIGHT BACK AFTER THIS.
>> GOOD DAY, CITIZENS. IT'S WITH REGRET THAT I INFORM YOU THAT THE END IS NEAR FOR ME.
I'M OLD. I'M TIRED. I'M WEAK.
BUT DON'T GO THINKING THAT YOU'VE WON THE WAR AGAINST THE FLU.
BEFORE I GO TO THAT BIG PETRIE DISH IN THE SKY, I WILL FIND A SUITABLE REPLACEMENT. BE WARNED.
>> LAST YEAR, AN ELDERLY HOSPITALIZED PATIENT WITH PNEUMONIA WAS GETTING BETTER
AFTER THREE DAYS ON POWERFUL ANTIBIOTICS, WHEN BLOODY DIARRHEA, CRAMPING, AND FEVER
BEGAN AND HIS OVERALL CONDITION STARTED TO DETERIORATE.
HIS STOOL TEST WAS POSITIVE FOR C. DIFFICILE AND HE GOT BETTER ON A DIFFERENT TYPE OF ANTIBIOTIC.
THIS HAPPENED BECAUSE TOO MANY OF THE GOOD MICROSCOPIC ORGANISMS, WHICH USUALLY
COLONIZE THE INTESTINAL TRACT, WERE DESTROYED BY THE ANTIBIOTICS WE GAVE HIM.
THIS THREW OFF AN IMPORTANT BALANCE OF NATURE, AND SIMILAR TO A LAWN WITH A PATCH OF
DESTROYED GRASS, THE WEEDS INVADED.
IT SOUNDS LIKE A SCI-FI MOVIE, BUT IT'S NOT.
SCIENTISTS HAVE DISCOVERED LARGE NUMBERS OF MICROCOMMUNITIES AROUND AND
WITHIN EVERY LIVING PLANT AND ANIMAL.
SURPRISINGLY MANY OF THESE 'INVADERS' ARE NECESSARY AND HELPFUL TO THE HOST, ALTHOUGH
SOME CAUSE NO BENEFIT, AND SOME CAN BE HARMFUL. MICROSCOPIC ORGANISMS INCLUDE
BACTERIA, FUNGI, VIRUSES, AND PARASITES AND ARE CALLED 'MICROBIOTA,' 'MICROBIOME'
WHEN REFERRING TO THE GENETIC MAKE-UP OF THE TINY
COMMUNITIES, OR MORE COMMONLY THE 'NORMAL FLORA.' HELPFUL NONHUMAN EXAMPLES
INCLUDE BACTERIA FIXING NITROGEN ON ALFALFA, FERTILIZING PLANT AND
SURROUNDING SOIL; OR ORGANISMS LIVING IN THE RUMEN OF CATTLE MAKING GRASS TURN INTO ABSORBABLE NUTRITIOUS FOOD.
THE HUMAN MICROBIOME HAS UP TO TEN TIMES AS MANY NONHUMAN CELLS AS HUMAN AND INVOLVE
MANY ORGAN SYSTEMS INCLUDING MAMMARY GLANDS, SKIN CELLS, LUNGS, MOUTH, AND EYES.
THE AREA WHERE MOST NORMAL FLORA RESIDE, HOWEVER, IS WITHIN THE GUT OR GASTROINTESTINAL TRACT.
FROM THE FIRST MINUTE AFTER BIRTH, THE BABY'S GUT IS EXPOSED TO A
MICROORGANISM-RICH WORLD. IT STARTS WITH TRAVEL THROUGH THE VAGINAL CANAL FOLLOWED BY ORAL EXPOSURE TO SKIN AND MILK
FLORA WHILE SUCKLING AT MAMA'S BREASTS. OVER THE NEXT YEAR, BABY'S
NORMAL FLORA DEVELOPS AND HELPS THE INFANT BREAK DOWN DIETARY FIBER AND FAT WHILE
PROVIDING FOR A BARRIER TO INVASIVE ORGANISMS. AMAZINGLY FOREIGN
MICROCOMMUNITIES ALSO HELP SYNTHESIZE VITAMINS, METABOLIZE HARMFUL TOXINS,
REDUCE INFLAMMATION, ENHANCE IMMUNE ACTIVITY, AND PRODUCE HORMONES.
WHEN HUMAN NORMAL GUT FLORA IS DEPLETED BY WELL-INTENTIONED ANTIBIOTICS, AN UNINTENDED
CONSEQUENCE MAY BE A CATASTROPHIC OVERGROWTH OF INVASIVE BACTERIA.
THE MOST DANGEROUS OPPORTUNISTIC INFECTION IS CALLED CLOSTRIDIUM DIFFICILE OR C. DIF.
THIS TYPE OF INVASIVE OVERGROWTH WAS RESPONSIBLE FOR ABOUT A HALF MILLION
INFECTIONS IN 2011 WITH 29,000 OF THOSE DYING WITHIN THE FIRST MONTH.
TAKE-HOME MESSAGE: AVOID ANTIBIOTICS UNLESS NECESSARY. IT'S NOT NICE TO MESS WITH NORMAL FLORA.
>> A BIG THANK YOU TO OUR GUESTS DR. CRISTINA HILL JENSEN AND DR. TIM RIDGWAY.
WE TRULY APPRECIATE THEIR WILLINGNESS TO TRAVEL TO OUR STUDIO AND SPEND THIS TIME
SHARING THEIR KNOWLEDGE IS GENUINELY APPRECIATED.
182 NEW CASES OF FLU REPORTED THIS WEEK AND OVER 400 PEOPLE HAVE BEEN HOSPITALIZED WITH
THE FLU IN SOUTH DAKOTA THIS YEAR.
DO NOT DELAY, GET YOUR FLU VACCINE NOW. IT'S NOT TOO LATE.
AND REDUCE YOUR CHANCES OF CATCHING THE FLU BUG THIS SEASON.
THAT DOES IT FOR TONIGHT, FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC,
" UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
>> WE WILL DO ALMOST ANYTHING TO RELIEVE PAIN,
BUT WHEN DOES RELIEF TURN INTO ADDICTION AND CAUSE ADDITIONAL HEALTH PROBLEMS?
RISKS OF DAILY OPIOIDS FOR PAIN. NEXT TIME "ON CALL WITH THE PRAIRIE DOC."
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